Provider Demographics
NPI:1033454954
Name:MYERS, MIKAL MAURICE (MT)
Entity Type:Individual
Prefix:
First Name:MIKAL
Middle Name:MAURICE
Last Name:MYERS
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 W FOOTHILL BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-2764
Mailing Address - Country:US
Mailing Address - Phone:909-717-2753
Mailing Address - Fax:
Practice Address - Street 1:226 W FOOTHILL BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-2764
Practice Address - Country:US
Practice Address - Phone:909-717-2753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist